 <div class="row">
                <div class="col-lg-12">
                    <h1 class="page-header">Registrer varekøb og Registrer udgifter</h1>
                </div>
                <!-- /.col-lg-12 -->
</div>

 <div class="row">
                <div class="col-lg-6">
                    <div class="panel panel-default">
                        <div class="panel-body">
                            <div class="row">
                                <div class="col-lg-6">
                                    Bilagsnummer:
                                    <input class="form-control" id="disabledInput" type="text" placeholder="20" disabled="">
                                    <br/>
                                    Dato:<br/>
                                    <input type="text" class="span2" value="02-16-2012" id="dp1">
                                </div>
                                <div class="col-lg-6">
                                    Købt fra:
                                    <select class="form-control">
                                        <option value="one">Danmark</option>
                                    </select>
                                    <br/>
                                    Beholding:
                                    <select class="form-control">
                                      <option>1</option>
                                    </select>
                                </div>

                            </div>
                            Tekst:
                             <input type="text" class="form-control">
                             <div class="row">
                                <div class="col-lg-6">
                                    Beløb:
                                    <input class="form-control" placeholder="0,00">
                                    <br/>
                                </div>
                                <div class="col-lg-6">
                                    Moms:
                                    <input class="form-control" id="disabledInput" type="text" placeholder="0,00" disabled="">
                                    <br/>
                                </div>
                               </div>
                                 <div class="well">
                                 Konto:
                                    <select class="form-control">
                                        <option value="one">Vareudgifter</option>
                                    </select>
                                 </div>
                                <div class="row">
                                    <div class="col-lg-6">
                                        Subtotal:
                                        <br/>
                                        <h4>Total:</h4>
                                    </div>
                                    <div class="col-lg-6">
                                        <div class="pull-right">
                                       0,00
                                     <br/>
                                        <h4>0,00</h4>
                                        </div>
                                    </div>
                               </div>
                             <hr>
                                <p class="pull-right"> 
                                <button type="button" class="btn">Gem som klade</button>
                                <button type="button" class="btn btn-success">Godkend</button>
                            </p>    
                        </div>
                        <!-- /.panel-body -->
                    </div>
                    <!-- /.panel -->

                </div>
                <!-- /.col-lg-6 -->
                <div class="col-lg-6">
                    <img src="http://upload.wikimedia.org/wikipedia/commons/0/0b/ReceiptSwiss.jpg" style='width:100%;' alt="Null">
                </div>
                <br/>
                <!-- /.col-lg-6 -->
</div>